Bernstein Medical - Center for Hair Restoration - Second Hair Transplant
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Q: How Many Hair Transplants Will I Need? — E.E., New York, N.Y.

A: The first session of a hair transplant should be designed as a stand-alone procedure with the following three goals:

  1. Establishing a permanent frame to the face by creating, or reinforcing, the frontal hairline.
  2. Providing coverage to the thinning, or bald, areas of the scalp with the hair transplant extending at least to the vertex transition point.
  3. Adding sufficient density so that the result will look natural.

Achieving all of these goals will allow the first procedure to stand on its own.

Because of this, many people feel one hair transplant is sufficient.

Reasons for Second Hair Transplant

While the first session of a hair transplant is designed to stand on its own, there are several reasons why one would want a second hair transplant, such as increasing the density in a previously transplanted area; refining the hairline created in the first transplant; focusing on increased crown coverage, when appropriate; or addressing further hair loss that’s occurred after the first transplant.

Because of this last reason, addressing further hair loss, careful patient evaluation and surgical planning is needed to take into account your donor reserve and the likely extent of any future balding in the planning of your first transplant session.

Wait at least 10 to 12 months Before Getting a Second Hair Transplant

If a second transplant is warranted, patients are advised to wait at least 10 to 12 months after the first transplant before considering a second. This is because over the course of the first year, the first transplanted hairs have grown in and the progressive increase in a hair’s diameter, texture and length can markedly change the look of the hair restoration — this may influence the way a patient wants to groom his/her hair, and only after the hair has reached styling length can the patient and physician make the best aesthetic judgments regarding the placement of additional grafts.

For patients having an FUT (strip) procedure, another reason to delay a second hair transplant session for this time period is that scalp laxity will continue to improve making the donor hair easier to harvest.

You can view our Hair Transplant Photos by the number of sessions each patient has had:

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Q: For patients who intend to keep their hair parted on the left side, do you follow any rule of making the left side more dense then the right or is it distributed evenly? — M.S., Simi Valley, C.A.

A: On a first hair transplant procedure, I generally place the sites/grafts symmetrically, even if a patient combs his hair to one side. The reason is that the person may change his styling after the procedure and I like to have the first hair transplant symmetrical for maximum flexibility. An exception would be a person with limited donor reserves. In this case, weighting on the part side is appropriate in the first procedure. Once the first hair transplant grows in and the person decides how he wants to wear his hair long-term a second transplant can be weighted to accommodate this. Weighting can be done in one, or both, of two ways: 1) by placing the sites closer together on the part side or 2) by placing slightly larger follicular units on the part side.

If a person decides to comb his hair back, then forward weighting is used. For greater details on this, please see some of my publications where I address the aesthetics of hair transplantation:

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Q: Is it more important to do scalp exercises before the first procedure or the second? — P.P., Richmond, V.A.

A: When the scalp is tight, it can be useful for either the first or the second hair transplant.

Keep in mind, however, that the scalp will naturally stretch between hair transplant procedures, so that if exercises were not needed for the first procedure, they will generally not be needed for the second.

In our practice, we generally wait one year between hair restoration sessions so that we can see the full cosmetic impact of the first procedure and give the scalp laxity a chance to return to normal on its own.

In addition, there is a risk that active massage after the first procedure may widen the donor scar. Therefore, before considering massage before a second hair transplant, make sure that enough time has elapsed between procedures so that stretching of the scar will not be a be a problem.

In general, since the scalp will normally continue to relax for up to a year after a procedure, it makes sense that when there is a tight scalp, one should wait at least a year before considering the next hair transplant session. If massage is contemplated, it should be started one year after the prior procedure. This will give the scalp a chance to loosen naturally and will ensure that the massage will not stretch the donor scar.

In my opinion, it is a mistake to plan hair restoration sessions too close together in patients where scalp laxity is a constraint.

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Q: In which procedure do you generally see more of a change, the first or the second? — N.N., Flatiron, N.Y.

A: The answer depends upon the patient’s baldness. If they are very bald, the first session will be the most noticeable, since going from no hair to hair is much more dramatic than going from some hair to more hair. In addition, if someone is very bald, the first session is generally the largest, with less hair being transplanted in the second.

The situation is different if someone has had a hair transplant with only a limited amount of hair loss. In this case, the first session may be small (since that is all they need at the time) and the second session, performed after the person has lost additional hair, may be significantly larger.

In addition, while the impact of the first session was lessened by the progression of the person’s hair loss, the second session was superimposed on existing, permanently transplanted hair and may be more dramatic.

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Q: My first hair transplant was a breeze. Will a second procedure be any different than the first? — B.B., Murray Hill, N.Y.

A: Generally in a second procedure, a patient can expect less swelling post-up although the reason for this is not known.

There will also generally be less shedding in the second hair transplant session since the weak miniaturized hair that will be shed is often lost in the first session and the previously transplanted hair is generally more resistant to shedding.

In a second session we generally, but not always, transplant fewer numbers of grafts.

If the old scar in incorporated into the new incision, then there will be slightly less hairs per graft since the density in and around the scar will be slightly altered.

For those who are bald, the second hair restoration is sometimes less dramatic than the first since the second is used for fine tuning rather than taking the person from completely bald to having hair.

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Q: I had my second hair restoration procedure nearly 5 months back. New hair in the front part of the head is growing well, but the crown is growing slow. Is this common? Also does the new hair grow more slowly after second hair transplant procedure? — B.V., Richmond, U.K.

A: Yes, it is typical for hair in the crown to grow more slowly than the front and top of the scalp and the second procedure generally grows more slowly than the first.

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Q: I recently had a hair transplant procedure done in Florida and it has been about 8 months. When I am in direct overhead light and when sunlight is behind me, I see many tiny holes that are not visible under normal light. I know these are where they placed the transplanted hair but need to know if there is a way to remove these tiny holes. I am obviously not getting any answers from the doctor that performed the hair restoration. I am wondering if dermal fillers, dermabrasion, or laser treatment would work to fix this and if so, do you offer these treatments?

A: This condition is often referred to as pitting and occurs when grafts are placed below the surface of the skin. It is more common with large grafts rather than small ones and is almost never seen in Follicular Unit Transplantation (FUT).

In general, visible holes can result from mini-micrografting hair transplant procedures where the grafts (and thus the recipient sites needed to hold them) are larger than approximately 1.2mm. Recipients sites smaller than 1.2 rarely leave any mark. In follicular unit hair transplant procedures, the grafts will fit into sites smaller than 1.2mm so surface changes are generally not seen (even if the grafts are not placed flush with the skin).

It is difficult to fix the holes directly with the methods you listed as fillers do not fix well defined holes and laser-abrasion and dermabrasion may destroy the surrounding hair.

A properly performed second procedure that places follicular unit grafts in the area should correct the problem.

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Q: In my first hair transplantation procedure, I wanted to be as conservative as possible and focus on thickening the thinning hair on top of my head and lowering the hairline minimally. Is it still possible to lower the hairline further in a second hair restoration procedure? Is there an “ideal” time period for a second hair transplant after the first? — B.B., Meatpacking, N.Y.

A: It is possible to lower the hairline with a second hair transplant, but the doctor must be certain that you have enough donor hair so that the transplanted pattern will look natural long-term.

Unless there is some pressing reason that you had to have a second session sooner, I would wait a minimum of 10-12 months between hair restoration procedures so that you can see the full cosmetic impact of the first session.

As a hair transplant matures and thickens, the hairline will look lower as the eye doesn’t see as far into the scalp.

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Q: When a second hair transplant is performed, should there be a second incision or should it be incorporated into the first? – D.V., Inwood, N.Y.

A: It is a very common practice to make a second separate scar in the second hair restoration procedure. This is done to maximize the hair in the second session, and it is technically the easiest to perform. If you incorporate the old scar in the new incision, there will obviously be less hair. As long as the upper incision is still in the permanent zone, the hair quality will be good.

That said, in my practice I almost always use only one scar. The subsequent procedure would incorporate the first and extend the scar to one side or the other (or both). I generally use the old scar as one edge of the new strip so that there is only one incision into virgin scalp (rather than two).

There are a number of reasons for this technique.

  1. The hair will always be taken from the mid-portion of the permanent zone, so we utilize the thickest, most stable hair
  2. A line scar in this location is generally the least visible and most easily camouflaged with the persons existing hair
  3. One avoids making a scar too low that increases the risk of widening the scar
  4. One scar will be easier to camouflage with Follicular Unit Extraction (if this is ever necessary)
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Q: This is my second hair transplant and is seems like it is growing more slowly than my first. Is this normal? – J.D., Port Washington, N.Y.

A: It is common for a second hair transplant to take a bit longer to grow than the first, so this should be expected. It is also possible that there is some shedding from the procedure, or a continuation of your genetic hair loss.

Propecia may be helpful in this regard. It is important to wait at least a year for the transplant to grow in fully and to give a chance for any hair that was shed to regrow.

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Q: If a second hair transplant is performed before the first had a chance to grow could the second procedure destroy the follicles from the first? — B.M., Upper East Side, NYC

A: Hair from the second hair transplant session would not damage the follicles transplanted in the first session, even if follicular unit grafts were transplanted in exactly the same spot as in the first session.

The reason to wait until the hair grows in, however, is so that you can better plan the subsequent hair restoration procedure. If two follicular units are placed on top of each other or very close together, you will essentially be creating a mini-graft and the results will not look natural.

We advise waiting at least 8 months between sessions with 10-12 months being ideal so that the grafts of the second session can be evenly distributed among the grafts of the first.

The extra few months not only allow the surgeon to identify all of the previously transplanted grafts, but enables him to get a sense of the “look” of the first session (i.e. the wave, the density, and how the patient will ultimately want to comb his newly transplanted hair). This is very useful in guiding the placement of grafts in the second session to maximize its cosmetic benefit.

Read more about a second transplant
See before after hair transplant photos of patients who had a second procedure

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